TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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August 17 is my last chemo. I'm scheduled for implant exchange surgery with new PS on September 13th if I'm fit enough. I'm still waiting for an authorization from my insurance to go out of area for this surgery. If I have to fight them I will. I guess they often have to. I might have to write a scathing letter about my original PS. The leader of my supports group has helped women write these letters. Man what a difference a week makes. My new PS asked me to send him photos of BC reconstructions that I liked the look of so he could get a sense of my aesthetic. I emailed it on Friday not expecting a response for at least a few day if not more and he replied Saturday morning! ...two whole paragraphs asking for more dialogue about the desired shape and size.
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Hi Ailing,
I have done just as much investigation as you and maybe more. I have seen 5 BS, all top doctors and 4 PS. It’s all about the team, right? I have 5cm DCIS in left breast, high grade comedo necrosis,without estrogen or progesterone positive. I’m 64 and very active, lift heavy weights, yoga and spin 5 days a week. My dilemma is the size, plus margins would leave my 36 big B with a small breast. I have also said no to radiation for a lot of obvious reasons and don’t want to take any chances.
Two of the PS said prepectoral with ET, one with direct implant and another said subpectoral with ET. I have definitely decided on prepectoral, but have to decide on which team. One is out of network and would cost more, but I think she’s great and would really do a great job. I have to decide tomorrow, but curious what you did and who were your doctors. Are you feeling pretty good and give me some details on your recovery.
I’m only doing one breast because my genomics risk score was low and no genetics that cause me to do both breasts.
Thank you and best of healing.
KarenH
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Hi Karen,
In the end I postponed my possible dates to the 2nd week of September to allow me to do a little more investigation!! A friend of a friend is actually doing prepectoral with TE on August 17th though...
To be honest I'm leaning more towards under the muscle now because 1) on a followup consultation it was explained that they don't actually cut the muscle but make a pocket. (If they were actually going to cut the muscle it would be a no brainer for me, but as I'm very thin and I feel like I may need the muscle over the implant at the upper pole to make things look natural and a little worried about the possibility of fat grafting reabsorption as I don't have that much fat to graft...). 2) As you noted, it's all about the team. My #1 BS who would pair with the prepectoral PS says in surgery he does not "cheat" ie. leave anything behind the nipple (this is my current area of research - I guess one school of thought is that it's fine to leave 5mm behind so long as you do a biopsy) and so between this and my body type, I will have very very thin flaps. From what I understand, slightly thicker flaps are a big help with prepectoral results and yes "not cheating" makes things a little more critical with the nipple so whatever method he thinks is safest I'm inclined to do now as I realize there's no room for error literally... and 3) I have spoken to a few friends of friends who seemed happy with the under the muscle results. One of them is going to let me see her boobs Wednesday
I now understand that at City of Hope they do make slightly thicker flaps (or at least, they leave 5mm of connective tissue behind the nipple if its clear) but favor all in one under the muscle. I have a follow up there Tuesday. It seems like the BS there would probably be a good fit for the prepectoral PS at Cedars, but, they are different hospitals.
I have come to the conclusion that there is not one "truth" but many. Surgeons will advocate for the method they are best at executing.
The doctors I've met are Dr. Armando Giuliano (BS, Cedars), Dr. Laura Kruper (BS, City of Hope), Dr. Randolph Sherman (PS, Cedars), Dr. Betty Kim (PS, Cedars), Dr. James Anderson (PS, City of Hope).
I have not 100% decided.
Let me know what you decide and your doctors as well! Trust you will have a good result with anyone you choose
Aisling x
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I had my dance weekend!!!! YAY! It was great! I can't believe how time is flying!! Now the countdown to my surgery.......15 days........I received my "Brobe" today......Fits perfectly and is super soft & comfy. Me & my family are heading out to South Dakota for some camping next week to see Mt Rushmore before my surgery. We will be home on the weekend before my surgery so I can be home to relax, pack and prepare.
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beautiful pics Druanne!! I'm 4 days out from exchange and fat grafting. Doing well but belly is super bruised from the fat grafting. I didn't have a lot of fat to spare so that made it a little tougher I think. I know everyone says step away from the mirror lol and I do. I'm pre pec and seem to be smaller than I thought I would and a little uneven of course. Just wondering if I will appear a bit bigger as things settle down? Maybe this is it. Either way glad its over
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Hi DebAL! Thanks!!!!
I am glad it is over for you! I am also having prepec with tissue expanders. I asked my PS if I could go one cup smaller. How long has this journey been for you??
Oh I just looked at your signature!!! DUH!!! Since February! Is that typical? You are in my thoughts!!!!!0 -
Hey Druanne, I managed to get my fills all in by March 29 and could have had my exchange in May but had to wait due to chemo. Then I had to wait 6-9 weeks post chemo b4 PS would do it. Guessing my time frame is pretty typical since chemo was thrown in there. Enjoy your getaway before your surgery!! Have a wonderful time!
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Bless you DebAl
I don't need chemo as of right now. My BS said they will look through the breast tissue and see if it is all LCIS or if there is any cancer after my surgery. I am crossing my fingers I do not need chemo.
Thank you!! I am going to try to relax and have fun.
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Hi guys. Question for you all: did your PS create an alloderm or ADM pocket for your prepec implants, or were they just placed under the skin? I met with my new PS yesterday (the original guy quit without notice apparently) and she said she does not use alloderm to make the pocket, she just stitches the skin to the underlying muscle to hold the implant in place until scar tissue forms around it. Wondering what everyone else had, as all literature online indicates the use of alloderm or some other type of tissue support.
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hapa, I'm embarrassed to say I'm not sure but I will ask. I'm leaning towards yes there was tissue support.
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Talked with my PS's nurse today. They use alloderm.
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Yes - mine used Alloderm for support.
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Alloderm!!!! You need something to create the scaffold so the implants do not bottom out. This is why they did not do pre pectoral before Alloderm. I believe this is standard with pre pectoral. I would really question that approach and get a second opinion with another PS who does many pre pectoral reconstruction procedures. Good luck and keep us posted!
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I have been reading and found this verbage: "To avoid this issue, tissue expanders are now being placed above the chest muscle, termed prepectoral tissue expander breast reconstruction. In this approach, a support material, such as Alloderm, may be used to secure the position of the implant on top of the muscle, or the implant will simply be sutured into place using the attached tabs."
So it does sound like there are instances that they don't use it. I want the alloderm myself and am happy my PS uses it.
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I can't imagine how bad my result would look without the Alloderm. My skin is paper thin and needed the support.
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My new PS plans to wrap the implant in ADM (Alloderm is one brand name) at my exchange if my previous PS did not use it with the expanders.
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My PS said he covers the front of the implant with Alloderm. I've read that some PS totally wrap the implant with the Alloderm. I think the theory is that the Alloderm provides an extra layer of protection between implant and skin flap, and it eventually gets incorporated into your tissue, as blood vessels will grow into it over time.
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alloderm for me
The way I understand it is that the alloderm acts as a matrix for the tissue cells to grow into, thus making the implant secure. The implant is so large, and knowing what I know professionally about wound healing, I can't see how the scar tissue will grow around the implant to secure it without a matrix.JMHO
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just curious about what type of implant everyone has gone with? My PS has suggested high profile rounds but I’m afraid they’ll look too much like baseballs on my chest even with fat grafting. But if I go with moderate or moderate plus I’m afraid of rippling. Any input or experiences welcome! Thanks ladies!
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I had Mentor High Profile rounds with fat grafting. They do not look like baseballs! Only a little rippling on the side. I can bend over and not have rippling in cleavage. I have only tried that maneuver in a bra:-). Just checking to see what general public would see.
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Does anyone know if there is a way to private message photos???
Thanks
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Yes, it's easy to private message photos.
I have Natrelle Inspira SCX implants. The are the firmest, most highly projected on the market. I also had fat grafting and they look very good and zero ripples. I had horrendous rippling with Natrelle 410 sub pecs.
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SSL, I have mentor high profile rounds. I'm just 10 days out from exchange so still some swelling and bruising but things look better each day and I think I'll be pleased with the end result.
Maybe it's just me but boy did I bruise badly with the fat grafting. I'm on the thinner side and PS said on a few occasions it would take some work to get the fat he needed. I have quite the color scheme going on on my belly but getting better each day now. I found in compared to mastectomy this was easier, more of a severe soreness than pain. Best wishes to those going in for surgery soon!
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I have Seri Silk Mesh, with Mentor Anatomic Silicone Implants. The PS used the Seri ADM to wrap around my implant. Seems ok.
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Question for all of you prepectoral ladies... either through experience or being told by your PS, how much "settling" of our implants should we expect? My PS said he would take a look between 4 - 7 months post exchange. Just wondering what I might expect to happen during that time?
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hi simone, I imagine for swelling to be completely gone and the body to adapt to the new implants. I had a lot of "pocket work" on one side. Extra work needed so implant didn't slip to the side. I had seen the term on the threads but didn't really know what it meant. My side with the extra work is a little more swollen, sore and I noticed a slightly different angle at the cleavage. I was told this will settle with time. I had fat grafting done at the time of exchange. May need a second graft but it's too early to tell yet. This early on things look pretty good considering.
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Thanks DebAL! So much sub pectoral experience on the board, but obviously not as much pre pectoral since it is pretty new
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Hello everyone, I had a revision from subpectoral to pre pectoral the day before yesterday. I somehow lost a message before I was able to post it this morning... so now I'm just going to shoot a short one out there and hope that someone knows someone who has done this revision surgery.
The short version of my history is, a lumpectomy with lymph nodes removed. Opted for bilateral mastectomies. Initially got "all under the muscle" saline implants that were used as tissue expanders. Next a dual-plane exchange surgery to Mentor smooth round High implants and now finally a couple of days ago a prepectoral revision with the same type of implant.
The reason that this is a more complicated surgery is because the muscles that have been snipped and stretched to accommodate the implants have now healed and attached to the skin of the breasts. During the revision the muscles have to be detached from the skin to be sutured back on to the chest wall and a new pocket made for the implants, with the aid of alloderm.
The dual-plane results were aesthetically very good when I was relaxed and pretty awful if I flexed at all but mainly I felt I was losing upper body strength by unconsciously not using my chest muscles because it was so damn uncomfortable.
Cheers
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Prepectoral Peeps: My exchange surgery is coming up in 10 days (hip hip hooray) and I'm wondering about recovery. I asked about this on the exchange forum and many women said they were in compression bras 24/7 for six weeks after recovery. However, I realize that prepectoral recovery is different from traditional. Do you wear a bra after? Will I need to wear loose fitting tops? How bad is swelling? How soon were you able to return to work? Anything you wish you had known before the surgery? I'm having surgery on a Tuesday and plan to return to work (I'm a teacher) the following Monday. I'm excited to get the TEs out but also bummed that I won't be able to use my arms for awhile - I coach middle school tennis and I love hitting with the kids.
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Hi ReadyAbout!
It is so great that you are getting ready for your prepectoral exchange surgery! I had mine on July 3. I had a really easy recovery. I had essentially no pain. I had very little swelling. Did a little fat grafting and that just felt a bit bruised. I was in a post surgical bra that a wore for a couple of weeks. Then I moved to a wireless bra for a couple of weeks until my incisions were completely healed. Then moved to underwire bra. I wear the bras 24/7 except for showering. I was told to use moisturizer after the incisions healed, wear supportive garment, and gentle massage. As for clothing, I wore whatever looked ok with the lovely post surgical bras they provided!
Yes, prepectoral is different. This seems to be the best thread for all things prepectoral.
Good luck and please continue to keep us posted. I have been keeping up with your journey and have really felt for you as you hit bumps in the road. We have really similar dates of Dx, similar Dx, close in age, etc.... Hopefully you will have smooth sailing from here on out!
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